I have long held that RALP likely improves the abilities of somesurgeons, just as Dr. Krongrad feels LRP improved his individual results are superior to RRP, as he said, “in his hands”. His own statement indicated that RRP, “in his hands,” “nearly always” required transfusions averaging 2 pints of blood. Although he stated in an article published in a Florida newspaper, he stated that his preferred LRP method would have saved 7,000 pints of blood, based on the erroneous assumption that each of 3,500 RRPs cited would have required comparable transfusion numbers that HE had experienced.

Statistically, modern RRPs reported in more current studies in the U.S. generally report transfusions as necessary in a substantial minority of surgeries performed. My own surgeon at Mayo Clinic reports that his own results show such a necessity in rare instances (substantially under 10%).

There is little doubt that if I was to have Dr. Krongrad do my surgery, I would want him to do LRP, but if I was to have Dr. Walsh (Johns Hopkins) or Dr. Catalona (Northwestern), both of whom have publicly stated they feel RRP is a superior technique (in their hands), then that is what I would want them to perform.

I tell those whom I counsel about prostate cancer, that there are two ways to approach treatment choice. One is to choose the procedure you wish to have performed and then find the “best” physician who regularly performs it, to provide the treatment. The second, is to choose the physician you prefer and have the treatment which he feels most comfortable in performing and feels most appropriate to your individual circumstances. Which method you prefer depends on many factors, including your own personality characteristics. What treatment you have and who you have
perform it, also depends on numerous factors, including economics, psychological and physical limitations and personal priorities.

Such decisions should be informed ones, and can and should, only be made by the patient after he feels he has acquired the necessary information to make it one. Once made, it should be approached with confidence and should never second-guessed, regardless of results, since no one can ever know what the result of any other choice would have been.

Should I really believe that there was a 31% disparity between results obtained by a trainee in RALP vs. a (presumably) experienced open surgeon for GS 7 disease?

I’d like to see these results replicated at a respectable institution.

That a laparoscopic surgeon “initiating” an RALP program at a hospital would have a far superior track record than an experienced open surgeon doesn’t pass the smell test. Sorry. We know RALP takes a long time to master.